hematology (PRO 3, Exam 3)

Once we give a unit or two of blood the patient starts to feel a whole lot better bc we replace the volume and RBC, the oxygen carrying capacity is much better. The problem is not actually fixed until we

identify the cause

(which stage of hemostasis?): the platelets will come and temporarily plug the holes on the top (surface)

platelet

(types of polycythemia):

secondary

-by z-track, draw up with one needle, switch the needle bc it can be irritating, injected into the skin

IM iron administration

normal platelets

150,000-450,000

Hematocrit is _____________ hemoglobin

3x

Normal neutrophil count

4,000-11,000

blood cells are what percentage of the blood?

40-45%

Plasma is what percentage of the blood?

55%

How long is iron therapy typically prescribed

6-12 months

Lifespan of platelets

7-10 days

A client with iron deficiency anemia is taking iron supplements. What nutrient should the nurse instruct the client to take supplements with in order to increase the absorption of iron? A. milk B. Orange Juice C. Food D. beta-carotene

B

A client with pernicious anemia asks why she must take vitamin B12 injections forever. Which is the nurse's best response? A. The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid B. The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient amounts of factor that allows the vitamin to be absorbed C. The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction D. The reason for your vitamin deficiency is an increased requirement for vitamin because of rapid red blood cell production

B

If a patient lacks intrinsic factor they will be on

B12 injections forever (it's once a month)

RBC WBC platelets hemoglobin hematocrit

CBC

Diagnostics for hematologic system

CBC and H&H

What helps with absorption of Iron

Vitamin C (take it with orange juice, strawberries, tomato juice)

ANC stands for

absolute neutrophil count

-chemotherapy can temporarily suppress bone marrow function causing

anemia

Can occur from contaminated blood -temp goes up

bacterial contamination

two components of blood

blood cells and plasma

-shortness of breath -back pain -itching -blood in the urine -can have reaction in as small as 5 mL of blood

blood transfusion reactions

blood formation in the

bone marrow

The blood and the blood forming sites

bone marrow and RE system

WBC count broken down

differential

WBC more involved with hypersensitivity reaction

eosinophils and basophils

Can purchase with stool softener in it, or gradually increasing fiber in the diet can help -has properties that cause constipation

iron

most common symptoms of RBC loss (anemia)

fatigue

Manifestations of anemia

fatigue, pallor/jaundice, cardiac/respiratory, nails, tongue, angular cheilosis, pica, GI elimination of blood

Formation of blood, development of different blood cells

hematopoiesis

tell us our RBC status and our hydration

hemoglobin and hematocrit

A destruction of RBCs, making enough but something is destroying them

hemolytic anemia

(Medical management of Anemia): -overactive bone marrow producing the wrong type of situation

immunosuppressive therapy

Vital signs for acute blood loss

increased HR, decreased BP

How do we give B12

injection (generally once a month around the same time)

anemia manifestations: If you have patients with a slow metabolism, hypothyroid its, they will manifest _____________ as someone with a normal metabolism bc their body is in a slower state overall

less strongly

WBC focusing primarily on fighting infection

leukocyte

WBC working on antibodies and your immune system

lymphocytes

Which anemia causes neurological problems

pernicious anemia (B12 deficiency)

(some patients may have all manifestations, some have none, and some have a mix)

manifestations of anemia

-When looking at the key areas that cause anemia, asking about the abdomen

men

(Types of anemia): -make a big cell, body trying to compensate from lack of cells -folic acid deficiency can occur as a result of PPL medication -B12 deficiency is the result of lack of intrinsic factor (see if patients have had some kind of gastric surgery, intrinsic factor is in the stomach and it is necessary for B12 absorption)

mesoblastic d/t folic acid or B12

WBC important for inflammation and infection

monocytes

Big thing that we see with B12 deficiency (lack of intrinsic factor

numbness and paresthesia (neurological symptoms)

If patient has a low platelet count, what is the safest way to administer medication

oral

these are the sites for blood formation in the bone marrow, also sites for bone marrow biopsy -this will help the pt maintain normal function, if the bone marrow produces the blood cells and they mature

pelvis, ribs, vertebrae, sternum

Most abundant blood cell

platelets

help with blood clotting

platelets

Manifestations of what? -rutty cheeks (plethura) -itching -predisposed to gout -headache

polycythemia

Medication is a chemical agent known as hydra (side effect is leukemia)

polycythemia

an example of an anemia that can be inherited

sickle cell

Liquid oral form of Iron can

stain the teeth

-Treatment for polycythemia -They will check the hemoglobin and hematocrit, draw off 500 mL of bloodat a time and discard it to see if they can get it down to a normal situation -have 1-2 treatments a week

therapeutic phlebotomy

(which stage of hemostasis?): the muscles in the damaged area are gaping to go into a spasm, bc it's a trigger to the body

vascular

Steps of hemostasis in order:

vascular, platelet, coagulation, clot retraction, clot destruction

You can also see lack of B12 in patients who are __________ (besides having lack of intrinsic factor) (need to have enough vitamin C as well to help with RBC production)

vegan

When iron is given IM it is administered how

z track

-Only ______________ given with a blood transfusion, nothing is to be given through blood, IV needs to be free-flowing patent line

.9 normal saline

how much blood is given at a time during a transfusion

1 unit

Neutropenia: almost certain for infection

<100

Neutropenia: significant risk for infection

<1000

Neutropenia: high risk for infection

<500

A client with anemia has been admitted to the medical surgical unit. Which assessment findings are characteristics of iron deficiency? A. night sweats, weight loss, and diarrhea B. dyspnea, tachycardia, and pallor C. nausea, vomiting, anorexia D. itching, rash, and jaundice

B

A client must receive a blood transfusion of packed red blood cells for severe anemia. What I.V. fluid should the nurse use to prime the tubing before hanging this blood product? A. No priming needed since blood must be infused alone per current guidelines B. dextrose 5% in water as this is considered an isotonic solution C. lactated ringer's solution as this is considered isotonic solution D. normal saline solution as this is considered isotonic solution

D

Where typically do we find intrinsic factor

GI system

With anemia we want to prevent

HF, angina, paresthesia, confusion

Which culture does not support the use of blood transfusion

Jehovah witness

-not a specific disease -sign of underlying disorder (something is causing a low count) -lower than normal hemoglobin -fewer than normal RBC's

anemia

Cracks and ulcerations on the sides of the mouth (manifestation of anemia)

angular cheilosis

bone marrow: -iliac crest, sternum -pt may feel some pressure -bandaid or dressing after -assess site, no shower for a day or two

areas of potential aspiration

must be ordered by a physician, sterile procedure, invasive, can be done at the bedside or a special procedures lab, pt may be given anti-anxiety meds, may have conscious sedation. Physician or technician will prep the area with butadiene or chlorhexadine, sterile drape put down. Can either put a needle in and aspirate the semi-fluid that comes out of the bone (about 5 mL) or they can actually go in and sample a piece of the bone

bone marrow biopsy/aspiration

What are nail changes of someone with anemia?

brittle

-increases workload on the heart -SOB -Tachy -Enlarged heart -nausea and vomiting -stools for occult blood, coffee ground emesis

cardiac and GI assessment of anemia

More manifestations of blood loss with patients who have concurrent problems like

cardiac and pulmonary

What causes jaundice as a clinical manifestation of anemia

cells become destroyed

(Types of anemia): -seen in patients with RA, chronic infections, cancer -treat more symptomatically

chronic disease (AKA anemia of inflammation)

(which stage of hemostasis?): clots destruct

clot destruction

(which stage of hemostasis?): clots dissolve

clot retraction

Transfusion Therapy Complications: -Reactions to the donors leukocytes, can be seen with repeated reactions

febrile non hemolytic

most common blood transfusion reaction and it usually only causes chills and a fever -non life threatening

febrile non-hemolytic

-chief cause of anemia is heavy menstrual flow (assent key)

females

Seen in patients with an autoimmune situation, mechanical heart valves, go through dialysis

hemolytic anemia

Prothrombin to thrombin coming into play -in some its we need to prolong this, pt that are on heparin, Coumadin, anticoagulation therapy, an induced situation). monitor these patients bleeding APPT, PT, and INR

hemostasis

hold pressure on the cut area, platelets plug the hole, clots, clots dissolve and destruct

hemostasis

can cause headache, can contribute to stroke

hypertension

thick blood; blocks blood flow, causes clots

hyperviscosity

A problem with production of RBCs

hypoproliferative

In this type of situation the patient isn't making enough red blood cells -look if there's something causing the bone marrow to be suppressed -can be decreased iron, folic acid deficiency, B12 deficiency

hypoproliferative

What are tongue changes of someone with anemia?

very smooth and red

If person has a part of there stomach removed, has gastritis, they may not be making enough __________________, leading to B12 deficiency

intrinsic factor

What do you need for absorption of B12 in the body

intrinsic factor

(Types of anemia) -Commonly due to blood loss (menstrual cycle for women, gastric problems for men like ulcers, gastritis, alcoholism)

iron deficiency

(Types of anemia) -Most common type

iron deficiency

-Sometimes certain treatments bring down -neutropenic precautions, visitors restricted, no fresh flowers or standing water -anything uncooked should not be in the room -check resp mucosa -careful of injections, indwelling catheters

neutropenia

Neutrophils less than 2,000

neutropenia

These patients will not exhibit the classic signs/symptoms of infection -look carefully for slight elevation of temp, slight redness in the skin -find the underlying cause of infection, draw blood cultures before starting antibiotic therapy

neutropenia

Treatment for what? -calmly stimulating factors to increase WBC -is it normal or is it a consequence of disease

neutropenia

-very important in phagocytosis, typically react within 1 hour when we have an exposure & we need to engulf the bacteria

neutrophils

When a bacteria, a virus is exposed in the body; these should get there within an hour to try to fight an infection.

neutrophils

As a student are you allowed to initiate blood transfusion therapy?

no

Which anemia causes numbness and paresthesia

pernicious anemia

(Types of anemia): The blood flow to the renal area is compromised, kidneys don't function, we don't secrete erythropoiesis. If these patients are on dialysis we can see hemolytic anemia bc the RBCs are destroyed as they go through the dialyzer -treat accordingly, can have synthetic epo or epicene to help increase RBC formation, watch very carefully increase H&H can increase volume

renal disease

Type of transfusion when they need a combination of plasma and blood cells

whole blood

Avoid alcohol with anemia?

yes

Should Iron be taken on an empty stomach?

yes (1-2 hours after meals)

Transfusion Therapy Complications: -Can occur from contaminated blood, we see temps go up

bacterial contamination

most definitive diagnostic of problem with blood count, we do not do this test to everyone -invasive procedure (informed consent)

bone marrow biopsy/aspiration

(types of polycythemia) Unknown cause:

Primary, polycythemia vera

carry oxygen, help with circulation from head to toe

RBC

This lab data indicates what? Apical pulse: 122, soft murmur Respirations: 26 per minute Blood pressure: 92/54 Level of Consciousness: confused and lethargic Red blood cells: 3.3 x 10^6

acute blood loss

Transfusion Therapy Complications: Most life threatening transfusion therapy complication, worst transfusion complication to have -wrong blood in the wrong patient

acute hemolytic

(Types of anemia) -RBC's, WBC's, and platelets down -anemia of unknown cause, can also be due to a congenital situation, or the result of chemical exposure -can be treated with bone marrow transplant or immunosuppressant therapy

aplastic

-Patient donates a year or two of blood, given back only to the same patient -can be frozen up to 10 years

autologous tranfusion

(which stage of hemostasis?): platelets begin to form blood clots underneath

coagulation

-hemoglobin and hematocrit -iron capacity -liquid proportion -breakdown of WBC

complete blood count with differential

Transfusion Therapy Complications: -Not a true abnormal response, it means that the patient is getting a lot of fluid

fluid overload

If pulse slowly rises, respirations slowly rise, and blood pressure slowly rises

fluid overload (call physician, slow the reaction)

Can actually have a hemoglobin that drops down to 9, with no symptoms, if the blood loss has been ____________-

gradual

(Medical management of Anemia): PBSCT

peripheral blood stem cell transplant

excessive craving for ice, patients may eat dirt and starch

pica

too many cells in the blood -increase RBC come with increased volume, so patient has hyper viscosity, hypervolemia, potential hypertension -risk for thrombosis or stroke

polycythemia

Three classifications of anemia

production, destruction, blood loss

Would you see more symptoms in a patient that lost blood quickly, or lost blood over a period of time?

quickly

With any serious reaction to blood transfusion you msut

stop blood immediately

Transfusion Therapy/Complications: -fever -chills -back pain -nausea -chest pain -dyspnea -changes in blood pressure

stop transfusion immediately (send back to lab and notify doctor)

One way to monitor HF in patients with anemia

weight themselves